Models

From Massachusetts to Oregon, there’s an increase in CHW models across the US and many feature team-based care. Among the reasons are provisions of the Patient Protection and Affordable Care Act, a growing focus on the Triple Aim, roll-out of payment reform initiatives, and greater recognition of the contributions of CHW strategies to reducing health disparities. Centers for Medicare and Medicaid Services grant programs such as the Community Transformation Grants and the Workforce Innovation Awards are supporting projects that demonstrate CHW strategies.

The mission of the Community Health Access Project (CHAP) is to improve health and social outcomes through the support provided by trained community health workers. The Pathways model developed as a strategy to track and improve accountability for positive, measurable changes as the CHWs helped their clients work through the system in dealing with specific health needs and social problems.

Three physicians started CHAP in 1999 with an initial focus on poor birth outcomes, geo-mapping low birth weight data in rural Ohio. Building on their experience with community-based outreach approaches while working in remote Alaska villages served by community health aides, they developed an outreach program using trained CHWs and pathways as the accountable outcome production model and achieved a significant reduction in low birth weight for enrolled clients.

Three principle guide Pathways: (1) Find: identify those at greatest risk; (2) Treat: ensure treatment through evidence-based interventions and evaluate their impact and (3) Measure: document and evaluate benchmarks and final outcomes.

Now there are sixteen core pathways as well as a growing network of Pathways projects in place and under development across the US.

According to CHAP, “Our current system will come right to your door if you have an expensive health care disaster. We are almost unreachable if you would like to receive a preventive treatment. We need focus, measures and contracts that hold the system accountable to find, treat and measure the outcome. Systems that not only reach the rich as they do now but also reach those more complex and high risk patients currently avoided by the American Health Care system.”

It wasn’t just because a few people cared that three patients with different but equally dire circumstances were helped. There’s another reason these individuals received the medical and social services they needed… again, again, and again.

In Ohio, a community health worker discovered a young woman living in a dilapidated apartment building. When the worker convinced the woman to seek medical care, they were both surprised to learn she was in her second trimester and pregnant with triplets. Later in the pregnancy when the woman wanted to leave the hospital against medical advice, the health worker convinced her to stay. All three babies were born so healthy, they didn’t need a ventilator, a typical need for triplets.

In Indiana, an unemployed father of an adolescent was promised a job in manufacturing. When the job didn’t materialize, the father thought he could pick up his former career as a truck driver. But high blood pressure kept him from being hired and fueled fears he would lose his son. On the night his blood pressure spiked so high he thought he was having a heart attack, he went to the emergency room. A health access worker referred him to a federally qualified health care center and helped him get his blood pressure under control. The man was not only hired, he could care for his son.

In Oklahoma, a homeless man with diabetes was showing up in the emergency room once or twice a week for 6 months. He wanted more than medical care; he wanted socialization. By putting him on a pathway for the local clinic to become his medical home for care—and comfort—his emergency room visits dropped to only twice during the next 6 months. Get more information here.

The Kresge Foundation recently launched the national Pathways Community certification initiative.

The Agency for Healthcare Quality and Research has released two publications on the model